156054 02/05/2008 CITY OF CARMEL, VENDOR: 069001 Page 1 of 1
,1L 4 ONE CIVIC SQUARE CRYSTAL FLASH CHECK AMOUNT: $83.90
s; ro CARMEL, INDIANA 46032 P O BOX 684
INDPLS IN 46206 CHECK NUMBER: 156054
CHECK DATE: 215/2008
bEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4231400 83.90 GASOLINE
a
Invoice
Crystal Flash Petroleum Corp.
P.O. Box 684
Indianapolis, IN 46206 USA
(317) 879 -2849
Account Number: 613410
(317) 879 -2855
Invoice Date: 01/21/08
Transactions from 01/01/08 to 01/15/08
City of Carmel- Police Dept.
One Civic Square
Attn: Shelly Lingelbaugh
Carmel, Indiana 46032 Pump
Transaction Date Purchase Site Product Odometer Qty price Amount
Card# 5671677 Car 113
01/15/08 12:21 pm CF CARMEL 87 NL 81,714 14.004 2.899 4160
Totals for Card# 5671677 14.004 40.60
Card# 5671682 Car 118
01/09/08 11:01 am CF CARMEL Mid NL 14,474 3.983 3.319 13.22
Totals for Card# 5671682 3.983 13.22
Card# 5671691 Car 127
01/01/08 02:04 pm CF CARMEL 87 NL 23,142 6.581 3.039 20.00
Totals for Card# 5671691 6.581 20.00
Card# 5671692 Car 128
01/09/08 11:01 am CF CARMEL Mid NL 1,854 4.359 3.319 14.47
Totals for Card# 5671692 4.359 14.47
Invoice Taxes Amount Due Exempt
Indiana Inspection Fee 0.29 No Products Total: 73.09
Indiana Excise Tax Gas 5.21 No Tax Total: 15.20
Federal Excise Tax Gas 5.29 No
Indiana Excise Tax Distillate 0.00 No Invoice Total: 88.29
Federal Excise Tax Distillate 0.00 No Tax Exempt T 4.39
Indiana Sales Tax 4.39 Yes Net Invoice: 83.90
Leaking Underground Storage Tank 0.03 No
Tax Total 15.20 Total Due: 83.90
If Payment received by Thursday, 01 /31 /2008Subtract from Total Due: $1.16
I Date For Period Amount
I Balance Fwd 0.00
I
i Invoice 01/08/08 12/16/07 to 12/31/07 13.30
Prev Invoice Balance 13.30
Current Invoice 83.90
Balance Due 97.20
Page 1 of 1
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
CITY OF CARMEL
An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Crystal Flash Petroleum Corp. Purchase Order No.
P.O. Box 684 Terms
Indianapolis, IN 46206 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
1/21 08 monthl payment 83.90
Total
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6.
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
Gry� ial Flash Petroleum Corp. IN SUM OF
P.O. Box 684
Indianaoplis, IN 46206
63.90
ON ACCOUNT OF APPROPRIATION FOR
police general fund
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. 1 hereby certify that the attached invoice(s), or
1110 314 83 bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
Tana»r� 79 20 OS
Signature
Chief of POlice
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund